MEDICARE: LINDSEY ANN COOK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WH0200X	Home Health Registered Nurse	1978872	MN

General Provider Information

NPI Number	:	1790479103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDSEY ANN COOK

Provider Business Mailing Address
First Line	:	807 CLOQUET AVE STE 200
Second Line	:
City	:	CLOQUET
State	:	MN
Zip	:	55720-1660
Country	:	US
Telephone Number	:	218-879-2035
Fax Number	:

Provider Business Practice Location Address
First Line	:	807 CLOQUET AVE STE 200
Second Line	:
City	:	CLOQUET
State	:	MN
Zip	:	55720-1660
Country	:	US
Telephone Number	:	218-879-2035
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2023
Last Update Date	:	06/07/2023

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